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Med Surg 2 > 30 - Hematologic Problems > Flashcards

30 - Hematologic Problems Flashcards

1
Q

normal platelet count

A

150-400k

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2
Q

thrombocytopenia count

A

less than 150k

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3
Q

impaired platelet production can be caused by….

A
  • cancer/disorders
  • aplastic anemia
  • drugs (chemo +)
  • immune thombocytopenia
  • infections
  • nutrnl deficency/alcoholism
  • radiation
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4
Q

incr platelet destruction can be caused by…

A
  • artificial surfaces (hemodyalysis, etc)
  • DIC
  • heparin
  • pregnancy
  • thrombotic microangiopathy (TTP, atypcl hemolytc UREMIC synd)
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5
Q

most common cause of accelerated platelet destruction

A

antibodies

-attacks pltlt when the drug binds to pltlt surface

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6
Q

most common acquired thrombocytopenia

A

IMMUNE thrombocytopenia [ITP]

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7
Q

ITP results fr

A
  • antipltlt antibodies
  • impaired pltlt productn
  • T-cell mediated destruction of pltlt
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8
Q

ITP MOA

A

platelets are coated w antibodies> spleen thinks they are foreign + destroys them w macrophages

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9
Q

platelets normally survive..

A

8-10 days

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10
Q

possibly causes of ITP

A
  • H.pylori
  • HIV
  • SLE
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11
Q

thrombotic thombocytopenic purpura [TTP]

A

-assoc w deficiency of ADAMTS13 enzyme
-w/o the enzyme, unusually large amt of vWF attach to pltlt
»>promotes aggregation
-clotting + bleeding occur at same time
-MEDICAL EMERGENCY

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12
Q

ADAMTS13

A

plasma enzyme

-breaks down the vWF clotting factr

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13
Q

vWF

A

von Willebrand clotting Factor

-most important protein-mediating platelet adhesion to damaged endothelial cells

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14
Q

TTP is often assoc w…

A

hemolytic uremic syndr

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15
Q

TTP is characterized by…

A

hemolytic anemia

  • thrombocytopenia
  • neurologc abnormalities
  • fever
  • renal abnormalities
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16
Q

Heparin Induced Thrombocytopenia [HIT]

A
  • platelet destruction + vascular endothelial injury are immune mediated response to heparin
  • life threatening
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17
Q

HIT should be suspected if…

A

pltlt count falls by more than 50% or falls below 150k

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18
Q

major problem of HIT

A

venous thrombosis

-arterial thrombosis can occur too

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19
Q

HIT complications

A
  • venous thrombosis

- arterial vascular infarcs> necrosis, stroke, end-organ damage

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20
Q

symptoms of bleeding w HIT are ___ bc…

A
  • unusual

- pltlt RARELY drops below 20k

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21
Q

HIT develops ____ after heparin therapy

A

5-10 days

22
Q

HIT MOA

A 
PF4 binds to heparin> 
then binds to pltlt>
pltlt activation> 
more PF4 released (pos feedback loop)>
antibodies are made against PF4-heparin-pltlt complx>
removed prematurely fr circultn>
thombocytopenia + pltlt-fibrin thrombi
23
Q

thrombocytopenia clinical manifestations

A
  • mostly asymptomatic
  • bleeding in mucosal or cutaneous
  • large bullous hemorrahge in buccal mucosa
  • bleeding into skin (petechiae, purpura, ecchymosis)
  • hemorrhage
24
Q

bleeding in mucosa examples

A

nosebleed + gingival bleeding

25
Q

bleeding into skin (petechiae, purpura, ecchymosis)

MOA

A

when pltlt count is low, RBC may leak out of blood vssls, + into skin

26
Q

manifestations that indicate internal blood loss

A
  • weakness
  • fainting
  • dizziness
  • tachycardia
  • ab pain
  • HYPO tension
27
Q

manifestations that indicate vascular ischemic problems/vascular thrombosis

A
  • confusion
  • headache
  • seizure
  • coma
28
Q

prolonged bleeding fr trauma/injury does NOT usually occur until platelets are less than….

A

50k

29
Q

spontaneous, life-threatening hemorrhages occur when count is less than..

A

20k

30
Q

platelet transfusions are not recommended unless it is below…

A

10k

31
Q

ITP lab results

A

-extreme low pltlt

32
Q

ITP tests

A
  • IgG assay
  • pltlt actvtn functn assay
  • H pylori
  • hep C
  • HIV
  • bone marrow biopsy
33
Q

TTP lab results

A

-medium decr in pltlt
incr in schistocytes, reticulocytes, LDH, bilirubin

decr in HgB, haptoglobin

34
Q

TTP tests

A
  • ADAMTS13
  • urinalysis for protein, blood
  • creatinine
  • LDH may help establish diagnosis
35
Q

HIT lab results

A
  • slight decr in pltlt

- maybe incr in schistocytes

36
Q

HIT tests

A
  • pltlt activatn functn assay

- PF4-heparin-platelet complex (antigen assay)

37
Q

when destruction is the cause, bone marrow analysis will show ____.
when decreased production is the cause, bone marrow analysis will show _____.

A

DSTRCTN: normal or increased megakaryocytes

DECR PRDCTN: absence or decr megakaryocytes

38
Q

Plasmapheresis is indicated for….

A

TTP + HIT

39
Q

……. are indicated for ITP + TTP

A
  • corticosteroids
  • rituximab
  • splenectomy
  • immunosuppressive
40
Q

ITP tx

A

-IVIG
-corticosteroids
-rituximab
-splenectomy
-immunosuppressive
-anti Rh
-platelet transfusion
romiplostim, eltrombopag, epsilon-aminocaproic acid

41
Q

TTP Tx

A
  • plasmapheresis
  • corticosteroids
  • rituximab
  • splenectomy
  • immunosuppressive
  • *ID + Tx of cause
42
Q

HIT Tx

A
  • direct thrombin inhibitor (ARGATOBRAN)
  • indirect thrombin inhibtr (FONDAPARINUX)
  • synthtc thrombin inhibitor (BIVALIRUDIN)
  • plasmapheresis
  • thombolytic agents
  • warfarin
43
Q

corticosteroids are used to treat ITP bc…

A
  • suppress phagocytic response to splenic macrophage
  • depress antibody formation
  • reduce capillary leakage
44
Q

IVIG or anti-Rh are given ITP bc…

A
  • pt is unresponsive to corticostrds or splenectomy

- competes w antiplatlet-antibodies for macrophage receptors in spleen

45
Q

thrombopoietin receptor agonists that are given to ITP…

A

-romiplostim
-eltrombopag
»>incr pltlt production

46
Q

example of immunosuppressive therapy

A

cyclosporine or cyclophosphemide

47
Q

if untreated, TTP usually results w…

A

renal disorder + death

48
Q

plasmapheresis works by providing TTP pts with _____ + removing_____. it also works w HIT by removing….

A

ADAM13 + approp vWF,
lrg vWF enzymes that are bound w pltlt.

platelet aggregating IgG fr blood

49
Q

platelet transfusion is CI with…TTP + HIT

A

bc it may bind + create more clotting

50
Q

warfarin for ___ should only be started when ____

A

HIT

-pltlt count has reached 150k

Med Surg 2 (13 decks)

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